One patient had multicentric GCT with two metachronous lesions, one in the proximal tibia and one in the cuneiform bone in the same extremity 15 years later. The initial lesion was extensive and complicated by fractures before and after surgery.
It was initially treated with curettage and cementing. The second lesion was treated with excision and arthrodesis with autograft. All lesions except one were treated with intralesional curettage. In 5 of these 15 patients some form of adjuvant was used: phenol in 2, high-speed bur in 2, and Pulsavac high-pressure irrigation with NaCl in 1. Further treatment details are described in Table 1. The patients in this material have a follow-up period ranging from 17 to months.
The patient with a sacral lesion associated with reduced strength and muscle atrophy preoperatively developed contracture of the Achilles tendon. The patient with an extensive proximal tibial lesion and multicentric disease has a varus knee with medial arthrosis as an adult.
One of the metatarsal lesions ended up with a shorter 3. One patient had a proximal tibial lesion that crossed the epiphyseal cartilage as a 9-year-old Figures 3 a and 3 b. Consequently an epiphysiodesis of the remaining epiphyseal cartilage was done to prevent an angular deformity.
The patient then developed a limb-length inequality which was treated with shortening osteotomies on the contralateral side. The patient had an unaffected function at last follow-up. Local recurrence developed in 2 patients Figure 4. One case in the distal fibula treated with curettage and cement initially developed a recurrence after 4 months. The other in the distal radius, treated with curettage and allograft initially, developed a recurrence after 14 months.
Both reoperations were done with recurettage and cementing. They both remain disease-free at 8 and 2,5 years, respectively, after the initial surgery.
One of the patients with a sacral lesion had to have a reoperation less than 1 month after the initial surgery, but this was a complicated case in a difficult location around the S1 nerve root and it was regarded as residual tumor and not a local recurrence. Some studies suggest a slight female predilection for GCT [ 2 , 3 , 5 ], but others have found no difference between the genders [ 1 , 4 ].
Kransdorf et al. This seems in accordance with existing literature. The anatomical region reported as most commonly affected is around the knee. Other fairly common locations are the distal radius, the proximal femur, the sacrum, and the proximal humerus. The small bones of the hands and feet, the vertebrae, the pelvis, and the skull are rarely involved [ 1 — 3 , 5 ].
The latter is more common in the first and second decades of life and are associated with a very good prognosis [ 2 , 4 , 14 ]. However Kransdorf et al. It is important to note that some authors on the other hand do not include giant cell reparative granulomas in their material on GCT. At our institution there was no prior tradition for differentiating between these two entities.
The 3 clavicular lesions and 1 in scapula are interesting as the flat bones are hardly ever affected. Most of the larger materials contain none [ 1 — 3 , 5 ]. There is not enough evidence to conclude that this is more common in the immature skeleton from our small case series alone. The localization within the bone is a point of special interest with regard to lesions in the immature skeleton. The typical GCT in an adult occurs at the end of a long bone with a metaphyseoepiphyseal location.
Lesions involving the metaphysis or the diaphysis without epiphyseal involvement are exceptionally rare. Historically the GCT was thought to occur in the epiphyseal part of the bone and then extend to the metaphysis [ 3 , 13 , 17 ]. However it became evident from isolated case reports and examples reported in larger series [ 3 , 13 , 18 ] that purely metaphyseal lesions were more common in young patients, often before closure of the epiphyseal cartilage.
Campanacci et al. They go on to say that cases with the tumor restricted exclusively to the epiphysis or apophysis were not known. They consequently advanced the hypothesis that GCT arise in the metaphysis and secondarily invade the epiphysis or apophysis. However, as early as Dr. He stated that when the very small and presumably early tumors of each category are analyzed, it becomes apparent that there are preferential sites of origin within each bone.
As an example he mentions GCTs, which when discovered while they are still small or before the epiphyseal plate closes are always located in the metaphysis. Several studies have supported the view that a metaphyseal origin is likely.
Rietveld et al. The lesion is capable of crossing the epiphyseal cartilage [ 10 ], but epiphyseal involvement in young patients increases with increasing age [ 11 ]. Next Article. Article Navigation.
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Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Osteoblastoma of the calvaria: report of two cases diagnosed with MRI and clinical review. Enzinger and Weiss's Soft Tissue Tumors. St Louis, Mo: Mosby, Inc; — Solitary infantile myofibromatosis of bone: an immunohistochemical and ultrastructural study.
Lumps and bumps on the head in children: use of CT and MR imaging in solving the clinical diagnostic dilemma. Author notes Reprints: Richard A. College of American Pathologists.
Prelesion radiographs were obtained to evaluate traumas and leg length discrepancies. Clinical relevance: Radiographs taken before diagnosis in children with osseous lesions are rare, but likely under recognized. Further studies of such instances in larger databases may provide a noninvasive means to reach diagnostic or etiologic conclusions.
Abstract Background: Benign bone tumors are common in children and are usually diagnosed incidentally or after pathologic fractures.
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